Provider Demographics
NPI:1346536992
Name:SHANNON, JULIA ELIZABETH (WHNP)
Entity Type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:ELIZABETH
Last Name:SHANNON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 SE 8TH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4253
Mailing Address - Country:US
Mailing Address - Phone:503-681-4145
Mailing Address - Fax:
Practice Address - Street 1:364 SE 8TH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4253
Practice Address - Country:US
Practice Address - Phone:503-681-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150052NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500635927Medicaid
WA1346536992Medicaid